Injured High School Athletes

Oftentimes, injured high school athletes want to "tough it out" and stay in the game. This means team physicians themselves have to be tough-about protecting young players.

"Team physicians can prevent many injuries by erring on the side of caution in making sideline decisions," advised Mary Lloyd Ireland, MD, team physician for Eastern Kentucky University in Lexington. Dr. Ireland participated in a media briefing on high school athletes at the 2002 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Knowing what's best

For the team physician, knowing what's best for the athlete can be tricky. Minor injuries can sometimes look more serious than they really are. More dire injuries can at times appear minor because the athlete experiences relatively little pain.

Said Dr. Ireland, "I've had coaches worry about a dislocated finger that looks bad, but is minor, and then not understand the seriousness of a concussion or neck injury. Serious multiple ligament injuries of the knee associated with nerve damage can be masked because the athlete does not feel pain."

The psychology of high school players adds to the complexity. Young athletes may not want to miss the game or disappoint their parents or coaches. Sometimes they may withhold information about how they're feeling.

Concussions

A concussion is one of the more common injuries suffered by high school athletes, particularly in contact sports like football. A concussion is a brain injury produced by direct or indirect head trauma with one or more of the following:

Amnesia
Memory loss
Difficulty concentrating
Headache
Sensitivity to light
Dizziness / vertigo

Delayed symptoms can include:

Sleep disturbance
Fatigue
Depression
Feeling slowed down in a fog

Physicians should "over treat" head injuries and keep athletes out of the game if they are "not right," appear to have memory loss or have a headache or nausea while running.

Risk for multiple concussions

Athletes who sustain one concussion have a two to four times greater risk of sustaining another concussion injury. Although rare, "second impact syndrome" can result from second closed head injury. This condition is marked by malignant brain swelling, increased intracranial pressure and cognitive impairment. It is more common among children and young adults.

Athletes who may have sustained a concussion should not be allowed to return to play until they are symptom free.

The U.S. Consumer Product Safety Commission (CPSC) estimated that there were about 358,000 concussion injuries relating to all consumer products in 2001. This does not include concussions suffered in car accidents, boating accidents and other ways not under CPSC jurisdiction. Of those injuries, about 28,000 were related to football in all age categories. About 18,700 were football-related and suffered by people 15-24 years old. About 17,000 were football-related and 15-19 years old.

A consensus statement on Sideline Preparedness for the Team Physician developed by AAOS, the American Academy of Family Physicians, the American College of Sports Medicine and several other organizations advises physicians to be conservative in allowing an injured high school athlete to return to play.

January 2003